I have spent 20 years working in nonprofit think tanks, the last 13 as a resident scholar with the Institute for Policy Innovation in Dallas. I also ran the Washington, D.C.-based Council for Affordable Health Insurance for nearly nine years. While I cover a range of political, economic and policy areas, I specialize in health policy. Prior to joining the think tanks, I taught philosophy. I received all three of my degrees—BBA in economics, masters in divinity and Ph.D. in humanities—from Texas universities. I was an ethicist for a medical school's panel reviewing human experimentation. I'm a member of the U.S. Commission on Civil Rights Texas Advisory Committee. For several years I was a political analyst for the USA Radio Network, and I hold a 6th degree black belt in Tae Kwon Do and still teach.

Baucus was referring to the implementation of ObamaCare: the missed deadlines, the confusion, and perhaps most importantly, the political fallout. But there are several other train wrecks, abject failures that have received little attention. And Republicans have had little or nothing to do with them.

Train Wreck No. 1 — Electronic health records, or EHRs, were supposed to create an electronic version of patients’ medical records that could be transferred from doctor to doctor or hospital to hospital, known as “interoperability.”

The Obama administration included $20 billion in the 2009 “stimulus bill” to promote the adoption of EHRs. Doctors and hospitals would be paid if they implemented EHRs in a “meaningful” way. The oft-repeated justification was that EHRs would save money—Obama cited an $81 billion savings that no one now believes—and improve the quality of care.

Well, the title of a January New York Times report reveals what many health policy experts predicted: “In Second Look, Few Savings from Digital Health Records.” As it turns out the only ones benefiting from EHRs are the companies that lobbied for the legislation, doubling some of those companies’ profits. As the Times points out, “the legislation has been a windfall to top executives at the leading health records companies.”

Had anyone taken the time to look at the VA and its hospital system, which has had versions of electronic health records for decades, they might have been a little less optimistic. A recent National Center for Policy Analysis report explains, “efforts to integrate Department of Defense medical records for service members with VA electronic health records for new veterans have failed, hamstringing attempts to provide a continuum of care for veterans with service-connected conditions, as well as costing taxpayers more than $1 billion dollars.”

Electronic health records may eventually become the gold standard in health care, but we’re not there yet and Obama’s billions of taxpayer dollars may have even slowed the progress.

Train Wreck No. 2 — President Obama rammed through the first major new entitlement in 45 years, but instead of people embracing it, most don’t want it; not businesses, not insurers, not doctors, not individuals. Apparently, not even Democrats who voted for it.

Reuters reports that the largest insurers, most of which initially supported the legislation, are very reluctant to enter the health insurance exchanges, where millions are supposed to have access to numerous health insurance options. “In recent days, executives at the four largest U.S. health insurers say they are likely to sell insurance plans on less than a third of the exchanges, reluctant to venture out beyond the states where they already offer coverage.”

And insurers aren’t alone. A majority of the public has supported repeal since the legislation passed, and the “repealers” have recently grown. Of course, business trade associations like the U.S. Chamber of Commerce and the National Federation of Independent Business have been fighting ObamaCare from the beginning.

The reception has been so bad that the Obama administration signed a $20 million public relations contract a year ago in an attempt to convince the public they want ObamaCare, and it just signed two more for another $10 million. That’s $30 million of your tax dollars to sell something most of you don’t want.

Train Wreck No. 3 — Health insurance premiums will explode. In January retired actuary Mark Litow and I published an opinion piece in the Wall Street Journal explaining why ObamaCare will push up premiums for some people by 100 percent.

In the last two months, as insurers have begun to announce their ObamaCare premiums, it’s clear we were right. States that largely destroyed their health insurance markets, like Massachusetts and New York, may not see much change—at least for a few years. But states that did a good job of ensuring access to affordable coverage will see their premiums skyrocket, especially in the individual market for younger adults.

Note that the rise in premiums is not a result of Obama’s sloppy implementation efforts; it’s due to the fact that the people writing the legislation didn’t have a clue how health insurance works or how it affects consumer choices. They thought—and Obama repeated it several times—that getting everyone covered would lower health care spending. They also thought that adding free services would reduce health care costs, when virtually any actuary would have told them the opposite.

Train Wreck No. 4 — And let’s not forget those with major pre-existing medical conditions, the uninsurables. ObamaCare put $5 billion aside to fund a new system of high risk pools to cover them—even though 35 state-based high risk pools already existed with about 220,000 people enrolled.

While Democratic planners expected some 375,000 people would be eligible to enroll in the program, only about 100,000 have. And yet the program is running out of money, and so the administration has closed it to new enrollees.

Let me repeat that: One of Obama’s primary justifications for demanding health care reform was to help the uninsurables get coverage, and he has closed that provision to new entrants.

Yes, ObamaCare will be a train wreck, many times over—just wait until the IRS cranks up its enforcement efforts or it becomes clear that people cannot get health insurance subsidies in the federally created exchanges.

Democrats went to great lengths to completely restructure the U.S. health care system and get all the “credit” for it. And now they are increasingly afraid they will.

Merrill Matthews is a resident scholar at the Institute for Policy Innovation in Dallas, Texas. Follow at http://twitter.com/MerrillMatthews

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I’d add a personal comment on point #1. Electronic records to “save” tons of money. i live and get my health care in France where costs are a small fraction of those in the US. Electronic records? Not here. When you get our x-ray, MRI, PET, CT, or whatever, you (as a visiting American) pay at the desk and take your results with you home and then on to your primary care doctor. It’s fast, simple and less expensive than any electronic system. What a concept. Tanking charge of our own health care needs!

I am the corporate manager for a food and beverage company in Texas. As it stands now we have more than 50 FTEs and would be considered a “large employer” under the Affordable Car Act. In an attempt to determined whether we can afford to offer ACA complaint insurance to our full time employees, I have spoken with private carriers and representative of SHOP. Both claim … as of yesterday… that they do not now what the cost of coverage will be for a single employee under the lowest tier ["bronze"] plan compliant with the minimum essential requirements of the Act and “affordable” within the meaning on the Act.

More critically, in both cases I am told that to offer group health insurance in Texas, whether through a private carrier or the exchange, 70% – 75% minimum participation will be required to establish a group plan. In other words, the carrier will not write the insurance unless 75% of the employees eligible to participate [with some exception such as coverage under a spouses plan] elect to do so.

The ACA provides that if an employer offers “affordable” insurance which meets the minimum requirements of the ACT and an employee elects not to participate because he or she does not want to pay his/her “affordable” part of the premium there is no adverse consequence to the employer who can establish and maintain the group plan for those who DO elect to participate.

Layering on top of the ADA this minimum participation requirement means that if 25% – 30% or more employees eligible to participate in the group plan elect not to, the employer cannot establish or maintain a plan for ANYONE employed by that employer or affiliate group.

We know [and it is obvious otherwise the ACA would be unnecessary, and the individual's penalty for not having insurance under the ACA is nominal] ] from having attempted to offer insurance to our F&B employees before, the only way to entice the requisite % of employees to participate is to pay a greater % … virtually 100% …of their premium. Minimum participation is NOT REQUIRED BY THE ACA and by my calculation, adding this requirement increases the employer’s cost of providing ACA compliant insurance by 300% all paid with “found money”. It is far from “affordable” to businesses in the food and beverage, construction, lawn and landscape and other industries will high labor costs, modest wages, and low profit margins.

I have seen no mention or analysis of this issue in any literature about the ACA and in my view it is THE MOST IMPORTANT ISSUE facing companies like ours. In our case we cannot afford to carry anything close to 100% of the premiums for all employees and stay in business .. not even close.

We cannot BUDGET for it because no one I have conferred with will disclose the cost of ACA compliant insurance in Texas. I believe that number is known but is being kept close to the vest because it will blow the lid off the current debate, even for its supporters.

ObamaCare will become iconic for becoming a colossal bureaucratic failure of contemporary politics. There will be a multitude of participants at various levels operating not only on different pages but completely out of sync. And, not only does the original ObamaCare bill contain thousands of pages but, so does the separate set of regulations . . . which transcends into that many more rules, policies and procedures that will need to be further interpreted, tweaked and seamlessly implemented.

And, as for the IRS, one can only ‘imagine’ how it will be reasonably possible for the IRS to smoothly interact with the implementation of ObamaCare. . . without any significant systemic issues that will linger for years. Not possible. Ain’t goin to happen. A true train wreck in slow motion . . . along the same track as the US fiscal and monetary policy.

PLEASE take a look at this and get the word out. My comment is not a political statement nor a wholesale attack on the ACA. I emailed Max Baucus with the same concern and have heard nothing in reply. As my message to Sen Baucus said, I caucused for Obama in 2008 and voted a straight Democratic ticket in 2008 and 2012. I am the attorney who filed the petition to recall Firestone 500 tires in 1997 and for 25 years practiced labor law representing unions and individuals. Not exactly a poster boy for conservatism. At this point I am advising my business and others in the same bind that the ONLY certainty [if not sanity] for budgeting is to not offer employees group insurance and, if the company has over 50 full time employees, pay $2000 per full time employee over 30. The net effect of the ACA for businesses like mine will decrease the number of insured as well as move many employees from full time to part time. Again, not as a political reaction, but the best shot to stay in business. Thanks for listening. John Chamblee

I understand, John. And while I am a poster boy for conservatism (or at least try to be :)) there are real problems with the legislation that I don’t think the administration and CMS ever grasped that will make it difficult for even administration-friendly people to support. I was talking with a friend last night who is an executive with one of the major railroads. He told me that the company HR person is struggling because the legislation is forcing the company to change its coverage, which is bumping up against union contracts. And so they are having to renegotiate some aspects. And that’s creating a big headache. I’m not exactly sure why that is; it has to be a large self-funded plan which is grandfathered in, but their most be something that is causing the problem. So I want to contact the person to see if I can learn a little more. As far other companies, I don’t think we know yet how employers are going to respond. My guess is that many want to continue providing coverage, but will encounter what you have and decide it just won’t work — or at least it’s too complicated to try to make it work. It is very unfortunate.

Or if you have a healthy employee distribution and want to cover them go with self insurance backed up and administered by a major insurance company. It takes some guts but can be done and gets around some of the Obama Care foolishness.

All we can hope for on both sides of any issue is intellectual honesty .. which is rare these days.

I ran into the minimum participation problem when I was calculating my best guess about the cost to offer ACA complaint coverage to our full time employees expecting to offer it rather than throw away money paying the ACA penalty. What would have been economically feasible for my business instantly became impossible, not because the Act itself but in its implementation … i.e. by layering in the minimum participation requirement. Looking at it from the employee’s point of view, if the ACA penalty for declining the employer’s offer of ACA compliant insurance and not otherwise obtaining insurance through an exchange is the fraction of the cost of his or her affordable share, their decision is predictable if they don’t think they need insurance because they’re young and healthy. The Act is designed so that the employer will not be penalized for that decision .. however by layering on the minimum participation requirement, that’s the result.